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Posts Tagged ‘SEER data’

30-Day Mortality Associated With Primary Cytoreductive Surgery In Elderly Advanced Ovarian Cancer Patients Much Higher Than Previously Reported

Posted by Paul Cacciatore on August 24, 2011

Researchers affiliated with the University of Washington have determined that the 30-day mortality rate associated with primary cytoreductive surgery in elderly patients with advanced ovarian cancer is much higher than previously reported.

Researchers affiliated with the University of Washington have determined that the 30-day mortality rate associated with primary cytoreductive surgery in elderly patients with advanced ovarian cancer is much higher than previously reported. There research is based upon the analysis of statistics obtained from the National Cancer Institue (NCI) Surveillance, Epidemiology, and End Results (SEER) database (collectively, the NCI SEER database).

Melissa M. Thrall, M.D., Lead Study Author; Fellow, Department of Obstetrics & Gynecology, University of Washington School of Medicine

The lead author of the study is Melissa M. Thrall, M.D., a Fellow in the Department of Obstetrics & Gynecology, University of Washington School of Medicine.

The researchers used the NCI SEER database to identify a cohort of 5,475 women aged 65 and older, who had primary debulking surgery for stage III or IV epithelial ovarian cancer which was diagnosed from 1995 through 2005. Women were stratified by acuity (i.e., average severity of illness) of hospital admission. Multivariable analysis was performed to identify patient-related and treatment-related variables associated with 30-day mortality.

The overall 30-day mortality rate was 8.2% for the 5,475 women who had surgery for advanced ovarian cancer. Women admitted on an elective basis experienced a 30-day mortality rate of 5.6% (251/4,517), while those patients admitted on an emergency basis experienced a 30-day mortality of 20.1% (168/835).  The researcher determined that 84.4% of patients were admitted on an elective basis, 15.6% of patients were admitted on an emergency basis, and 2.2% of patients had an unknown admission status.

Emergency admission was associated with older age (median of 76.9 vs. 75.1 for elective admission), higher comorbidity scores, and stage IV disease (41.9% vs. 32.9%). Women admitted on an emergency basis had surgery performed more frequently in low-volume hospitals, by low-volume surgeons, and by surgeons other than gynecologic oncologists (p value <0.001). Emergency admission was also associated with significantly less use of neoadjuvant chemotherapy (2.99% vs. 13.39%, p <0.001).

Advancing age, increasing disease stage, and increasing comorbidity score were all associated with an increase in 30-day mortality (p <.05) among elective admissions. The mortality risk was not influenced significantly by race, income, marital status and other demographic and clinical factors.

A group of women at high risk who were admitted on an elective basis included those aged 75 or older with stage IV disease, and women aged 75 or older with stage III disease and a comorbidity score of 1 or more. The high risk group experienced a 30-day mortality rate of 12.7% (95% confidence interval: 10.7%–14.9%), and accounted for 25.7% of the study population and approximately 50% of the deaths.

Low-risk patients were defined by age 65 to 74, stage III or IV disease, and a morbidity score of less than or equal to one. The low-risk patients accounted for 48.7% of the study population and experienced a 30-day mortality rate of 3.64%. The remaining intermediate patients experienced a mortality rate of 6.05%.

Based upon their analyses, the researcher concluded that age, cancer stage, and comorbidity scores may be helpful to stratify patients admitted on an elective basis by predicted postoperative mortality risk. If validated in a prospective cohort study, these factors may help identify women who may benefit from alternative treatment strategies, such as neoadjuvant chemotherapy.

The study was supported by the Marsha Rivkin Center for Ovarian Cancer Research and by the National Cancer Institute.

Sources:

Related WORD of HOPE Ovarian Cancer Podcast

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Young Early-Stage Ovarian Cancer Patients Can Preserve Fertility

Posted by Paul Cacciatore on August 11, 2009

A new study finds that young women with early-stage ovarian cancer can preserve future fertility by keeping at least one ovary or the uterus without increasing the risk of dying from the disease. The study is published in the September 15, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

A new study finds that young women with early-stage ovarian cancer can preserve future fertility by keeping at least one ovary or the uterus without increasing the risk of dying from the disease. The study is published in the September 15, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

fertility

... “Given the potential reproductive and nonreproductive benefits of ovarian and uterine preservation, the benefits of conservative surgical management should be considered in young women with ovarian cancer” ...

Most cases of ovarian cancer are diagnosed at later stages and in older women. However, up to 17 percent of ovarian tumors occur in women 40 years of age or younger, many of whom have early stage disease. Surgery for ovarian cancer usually involves complete removal of the uterus (hysterectomy) and ovaries, which not only results in the loss of fertility, but also subjects young women to the long-term consequences of estrogen deprivation.

Jason Wright

Jason Wright, M.D., Assistant Professor, OB/GYN, Columbia University College of Physicians & Surgeons, New York City, NY

Researchers led by Jason Wright, M.D., of Columbia University College of Physicians and Surgeons in New York City conducted a study to examine the safety of fertility-conserving surgery in premenopausal women with ovarian cancer. This type of surgery conserves at least one ovary or the uterus.

The investigators analyzed data from women 50 years of age or younger who were diagnosed with early stage (stage I) ovarian cancer between 1988 and 2004 and who were registered in the National Cancer Institute’s Surveillance, Epidemiology and End Results database, a population-based cancer registry that includes approximately 26 percent of the US population. Patients who had both of their ovaries removed were compared with those who had only the cancerous ovary removed. A second analysis examined uterine conservation verus hysterectomy.

For their first analysis, the researchers identified 1,186 ovarian cancer patients. While most had both ovaries removed, about one in three (36 percent) had one ovary conserved. They found those in whom one ovary was saved had similar survival for up to at least five years.

To examine the effect of uterine preservation, the investigators studied a total of 2,911 women. While most of the women underwent hysterectomy, about one in four (23 percent) had uterine preservation. Uterine preservation also had no effect on survival.

Women who were younger, who were diagnosed in more recent years, and who resided in the eastern or western United States were more likely to undergo ovarian or uterine conservation.

These results are promising for the many young women who are diagnosed with ovarian cancer each year. An estimated 21,650 women in the United States were diagnosed with the disease in 2008. “Given the potential reproductive and nonreproductive benefits of ovarian and uterine preservation, the benefits of conservative surgical management should be considered in young women with ovarian cancer,” the authors concluded.

Source:  Wright JD, Shah M, Mathew L, et. al.  Fertility preservation in young women with epithelial ovarian cancer. CANCER; Published Online: August 10, 2009 (DOI: 10.1002/cncr.24461); Print Issue Date: September 15, 2009.

Comment: The key to this study is the concept that fertility preservation “should be considered in young women with ovarian cancer.”  As part of this consideration, the patient’s subtype of ovarian cancer may play an important role as well.  For example, a diagnosis of ovarian clear cell adenocarcinoma (OCCA) in a young adult woman should create a moment of pause in regard to fertility-sparing. The OCCA subtype of epithelial ovarian cancer can be extremely chemoresistant (even during first-line treatment), especially if the tumor histology indicates that the tumor possesses a dominant clear cell component or is a pure form of OCCA.  In addition, OCCA is a rare form of epithelial ovarian cancer in women worldwide (with the exception of Japanese foreign nationals). My hypothetical does not mean that fertility sparing should not be considered in the event of a OCCA diagnosis, it simply means that each woman should carefully discuss fertility-sparing with her board-certified gynecologic oncologist based upon the specific facts of her case, including tumor histology.

Posted in Fertility, Medical Study Results, Surgery | Tagged: , , , , , , , , , , , , , , | 1 Comment »

M.D. Anderson Study Predicts Dramatic Growth in Cancer Rates Among U.S. Elderly, Minorities

Posted by Paul Cacciatore on April 30, 2009

” … Over the next 20 years, the number of new cancer cases diagnosed annually in the United States will increase by 45 percent, from 1.6 million in 2010 to 2.3 million in 2030, with a dramatic spike in incidence predicted in the elderly and minority populations, according to research from The University of Texas M. D. Anderson Cancer Center. …Given these statistics, the role of screening and prevention strategies becomes all the more vital and should be strongly encouraged, said [Ben] Smith [M.D.]. … These findings also highlight two issues that must be addressed simultaneously: clinical trial participation and the increasing cost of cancer care. Historically, both older adults and minorities have been under-represented in such studies, and, therefore, vulnerable to sub-optimal cancer treatment. Simultaneously, over the past decade in particular, the cost of cancer care is growing at a rate that’s not sustainable. …”

“Research underscores impact on health care system, importance of screenings, prevention strategies, inclusive clinical trials

Cancer Newsline Podcast
M. D. Anderson audio player (click & play)
Dramatic Growth in Cancer Rates Among Elderly, Minorities

Over the next 20 years, the number of new cancer cases diagnosed annually in the United States will increase by 45 percent, from 1.6 million in 2010 to 2.3 million in 2030, with a dramatic spike in incidence predicted in the elderly and minority populations, according to research from The University of Texas M. D. Anderson Cancer Center.

The study, published online today in Journal of Clinical Oncology, is the first to determine such specific long-term cancer incidence projections. It predicts a 67 percent increase in the number of adults age-65-or-older diagnosed with cancer, from 1 million in 2010 to 1.6 million in 2030. In non-white individuals over the same 20-year span, the incidence is expected to increase by 100 percent, from 330,000 to 660,000.

Ben Smith, M.D., Adjunct Assistant Professor, Department of Radiation Oncology, The University of Texas M.D. Anderson Center

Ben Smith, M.D., Adjunct Assistant Professor, Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center

According to Ben Smith, M.D., adjunct assistant professor in M. D. Anderson’s Department of Radiation Oncology, the study underscores cancer’s growing stress on the U.S. health care system.

‘In 2030, 70 percent of all cancers will be diagnosed in the elderly and 28 percent in minorities, and the number of older adults diagnosed with cancer will be the same as the total number of Americans diagnosed with cancer in 2010,’ said Smith, the study’s senior author. ‘Also alarming is that a number of the types of cancers that are expected to increase, such as liver, stomach and pancreas, still have tremendously high mortality rates.’

Unless specific prevention and/or treatment strategies are discovered, cancer death rates also will increase dramatically, said Smith, who is currently on active military duty and is stationed at Lackland Air Force Base.

To conduct their research, Smith and his team accessed the United States Census Bureau statistics, updated in 2008 to project population growth through 2050, and the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) registry, the premier population-based cancer registry representing 26 percent of the country’s population. Cancer incidence rates were calculated by multiplying the age, sex, race and origin-specific population projections by the age, sex, race and origin-specific cancer incidence rates.

The researchers found that from 2010 to 2030, the population is expected to grow by 19 percent (from 305 to 365 million). The total number of cancer cases will increase by 45 percent (from 1.6 to 2.3 million), with a 67 percent increase in cancer incidence in older Americans (1 to 1.6 million), compared to an 11 percent increase in those under the age of 65 (.63 to .67 million).

With respect to race, a 100 percent increase in cancer is expected for minorities (.33 to .66 million); in contrast, in white Americans, a 31 percent increase is anticipated (1.3 to 1.7 million). The rates of cancer in blacks, American Indian-Alaska Native, multi-racial, Asian-Pacific Islanders and Hispanics will increase by 64 percent, 76 percent, 101 percent, 132 percent and 142 percent, respectively.

Regarding disease-specific findings, Smith and his team found that the leading cancer sites are expected to remain constant – breast, prostate, colon and lung. However, cancer sites with the greatest increase in incidence expected are: stomach (67 percent); liver (59 percent); myeloma (57 percent); pancreas (55 percent); and bladder (54 percent).

Given these statistics, the role of screening and prevention strategies becomes all the more vital and should be strongly encouraged, said Smith. In the study, Smith and his team site [sic]: vaccinations for hepatitis B and HPV; the chemoprevention agents tamoxifen and raloxifene; interventions for tobacco and alcohol; and removal of pre-malignant lesions, such as colon polyps.

These findings also highlight two issues that must be addressed simultaneously: clinical trial participation and the increasing cost of cancer care. Historically, both older adults and minorities have been under-represented in such studies, and, therefore, vulnerable to sub-optimal cancer treatment. Simultaneously, over the past decade in particular, the cost of cancer care is growing at a rate that’s not sustainable.

‘The fact that these two groups have been under-represented in clinical research participation, yet their incidence of cancer is growing so rapidly, reflects the need for therapeutic trials to be more inclusive and address issues that are particularly relevant to both populations,’ said Smith. ‘In addition, as we design clinical trials, we need to seek not only the treatment that will prolong survival, but prolong survival at a reasonable cost to patients. These are two issues that oncologists need to be much more concerned about and attuned to.’

Another issue that needs to be addressed is the shortage of health care professionals predicted. For example, according to a workforce assessment by American Society for Clinical Oncology (ASCO), the shortage of medical oncologists will impact the health care system by 2020. Smith said ASCO and other professional medical organizations beyond oncology are aware of the problem, and are actively engaged in efforts to try and grow the number of physicians, as well as encourage the careers of nurse practitioners and physician assistants who are part of the continuum of care, to best accommodate the increase in demand forecasted.

‘There’s no doubt the increasing incidence of cancer is a very important societal issue. There will not be one solution to this problem, but many different issues that need to be addressed to prepare for these changes,’ said Smith. ‘I’m afraid if we don’t come to grips with this as a society, health care may be the next bubble to burst.’

In addition to Smith, other M. D. Anderson authors on the study include: Thomas Buchholz, M.D., professor and chair of the Department of Radiation Oncology and the study’s senior author; Gabriel Hortobagyi, M.D., professor and chair of the Department of Breast Medical Oncology; and Grace Smith, M.D., Ph.D., assistant professor in the Department of Radiation Oncology. Arti Hurria, M.D., post-doctoral fellow in the Department of Medical Oncology, City of Hope Cancer Center, also is a contributing author on the study.”

Sources:

Posted in Clinical Trials, Early Detection, Healthcare, Medical Study Results, Prevention | Tagged: , , , , , , , , , , , , , , , , , , , , | Leave a Comment »

Prognosis Improves Over Time For Almost All Ovarian Cancer Survivors

Posted by Paul Cacciatore on May 7, 2008

Results showed that 5-year CS [conditional survival] improved for up to 5 years after diagnosis in almost all ovarian cancer groups, more than tripling in stage IV patients from 17 to 56 percent.

“Continuing prognosis improvement encouraging in ovarian cancer”

By Anita Wilkinson; 06 May 2008Gynecologic Oncology 2008; Advance online publication

“Medwire News: Encouraging study findings suggest that prognosis improves over time for almost all groups of ovarian cancer patients. Ovarian cancer survival is typically estimated from diagnosis, say Mehee Choi (The University of Texas Health Science Center at San Antonio, USA) and colleagues. However, they add that these projections are often discouraging and not necessarily pertinent for patients who have survived the initial treatment period, as prognosis after initial management is not static.

Believing conditional survival (CS) – the probability that patients who have survived for a designated period will be alive for another fixed interval – is more accurate, they applied this measure to 30,738 patients on a National Cancer Institute database [i.e., 1988 -2001 Surveillance Epidemiology and End Results (SEER) data]. Results showed that 5-year CS improved for up to 5 years after diagnosis in almost all ovarian cancer groups, more than tripling in stage IV patients from 17 to 56 percent. Patients with undifferentiated epithelioid histology saw 5-year CS increase from 29 percent at diagnosis to 84 percent after 5 years, and there were also big gains for those with serous histology. Choi et al conclude: ‘Five-year CS probability is an easily understandable measure that can be used to more accurately portray to a patient her current risk profile.’”

[Quoted Source: "Continuing prognosis improvement encouraging in ovarian cancer," by Anita Wilkinson, MedWire News Release dated May 6, 2008 (discussing the study entitled "Conditional survival in ovarian cancer: Results from the SEER dataset 1988-2001," Choi M. et. al., Gynecol Oncol. 2008 May;109(2):203-9)].

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